Healthcare Provider Details

I. General information

NPI: 1073774030
Provider Name (Legal Business Name): ALEXANDRIA RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 211
ALEXANDRIA LA
71301-3983
US

IV. Provider business mailing address

3311 PRESCOTT RD STE 211
ALEXANDRIA LA
71301-3983
US

V. Phone/Fax

Practice location:
  • Phone: 318-767-8393
  • Fax: 318-767-8399
Mailing address:
  • Phone: 318-767-8393
  • Fax: 318-767-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11711R
License Number StateLA

VIII. Authorized Official

Name: DR. MOHAMMAD IZZAT SHBEEB
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 318-767-8393